Retreat registration | Wakenda Rose

First Name

Last Name

Phone

Birthday

How did you hear about this retreat?

What inspires you about this retreat?

Have you ever attended a healing, Tantra or personal transformational retreat before? If so please describe.

Do you have a regular spiritual practice and if yes please describe? *

Do you have any medical conditions that we should know about or are you under the care of a mental health practitioner and please describe? *

Do you have any history of emotional, mental or sexual trauma history that you would like the facilitator to know about?

Is there anything else you feel you would like to share or should know about? *

Dietary restrictions or requests